Clinical Vignette
Mr. Z, 30 years old
Mr. Z is a 30-year-old single man who was born in China. He entered the United States with his parents as an undocumented immigrant in 1998 when he was 10 years old and is now residing in Massachusetts. He has been unable to find steady employment due to his immigration status. He has no health insurance and presents to the emergency room with a report of 6 months of worsening generalized anxiety and frequent panic attacks, irritability, and difficulties in initiating and maintaining sleep.
Mr. Z worries about his ability to remain in the U.S. and has been experiencing suicidal ideation since the DACA program was rescinded, further jeopardizing his future. He fears that this country is becoming less welcoming to immigrants and worries about his prospects for remaining in this country.
Factors that Put Asian Americans at Risk for Mental Health Problems
Racism, racial bias, and discrimination: Racism, racial bias, and discrimination contribute to Asian Americans’ experience of marginalization and alienation. Although many Asian Americans have achieved professional success, they may still encounter barriers preventing them from reaching leadership positions in their respective professions.
Racial stereotypes and profiling: Asian Americans are frequently stereotyped as being smart, hard-working, successful, and eager to enter and blend into American society. However, while many Asian Americans excel educationally and financially, others may struggle. The ‘model minority’ stereotype only exacerbates Asian Americans’ tendencies to not seek help, even in the face of mental illness.
Language barriers: English is not the primary language for some Asian American immigrants. For these, language barriers may pose challenges to acculturation and assimilation into American life. A common example of this occurs when an Asian American is ridiculed, misunderstood, or even bullied as a result of their accent.
Immigration status: The estimated 1.5 million undocumented Asian Americans (represent 14% of all undocumented immigrants in the U.S. They remain in perpetual fear of arrest, deportation, and separation from their families as well as the loss of businesses they have worked hard to build over the years.
Trauma: Immigration leaves people susceptible to trauma in various stages of the migration process. For example, older immigrants may have experienced trauma associated with historical events in their countries of origin such as China’s Cultural Revolution or the Vietnam War.
Low levels of mental health literacy: Some Asian Americans are unfamiliar with Western medical models of mental illness and the availability of effective treatment for several common psychiatric conditions. This knowledge gap leads to under-recognition and delayed treatment of their mental illness.
Stigma towards mental illnesses: Stigma surrounding mental illness may prevent some Asian Americans from admitting to symptoms of mental illness. They are also known to have the lowest rates of mental health service utilization among any racial or ethnic group. Medical literature shows that education about mental health reduces mental health stigma in Asian Americans. Mental illness can be stigmatized by some Asian cultures as a weakness in an individual and/or a collective failing or weakness of the individual’s entire social group.
Varying presentation of symptoms in different groups: Asian Americans may present in primary care settings with somatic complaints for underlying psychiatric conditions. For example, research has shown that a significant number of Asian Americans--including those of Chinese and Indian descent--with depression may present with insomnia and gastrointestinal issues. Insomnia itself may be an early sign of a psychiatric illness, such as post-traumatic stress disorder (PTSD), in Asian Americans who experienced political strife in their countries of origin such as Vietnam and Cambodia.
Back to Top